1
|
Zhang J, Wurzel DF, Perret JL, Lodge CJ, Walters EH, Dharmage SC. Chronic Bronchitis in Children and Adults: Definitions, Pathophysiology, Prevalence, Risk Factors, and Consequences. J Clin Med 2024; 13:2413. [PMID: 38673686 PMCID: PMC11051495 DOI: 10.3390/jcm13082413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
The complex nature of chronic bronchitis (CB) and changing definitions have contributed to challenges in understanding its aetiology and burden. In children, CB is characterised by persistent airway inflammation often linked to bacterial infections and is therefore termed "protracted bacterial bronchitis" (PBB). Longitudinal studies suggest that CB in childhood persists into adulthood in a subgroup. It can also be associated with future chronic respiratory diseases including asthma, bronchiectasis, and chronic obstructive pulmonary disease (COPD). Adult CB is traditionally associated with smoking, occupational exposures, and lower socioeconomic status. The interplay between risk factors, childhood CB, adult CB, and other chronic respiratory diseases is intricate, requiring comprehensive longitudinal studies for a clearer understanding of the natural history of CB across the lifespan. Such longitudinal studies have been scarce to date given the logistic challenges of maintaining them over time. In this review, we summarise current evidence on the evolution of the definitions, pathophysiology, risk factors, and consequences of childhood and adulthood chronic bronchitis.
Collapse
Affiliation(s)
- Jingwen Zhang
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3053, Australia; (J.Z.); (D.F.W.); (J.L.P.); (C.J.L.); (E.H.W.)
| | - Danielle F. Wurzel
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3053, Australia; (J.Z.); (D.F.W.); (J.L.P.); (C.J.L.); (E.H.W.)
- Murdoch Children’s Research Institute, The Royal Children’s Hospital, Melbourne, VIC 3052, Australia
| | - Jennifer L. Perret
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3053, Australia; (J.Z.); (D.F.W.); (J.L.P.); (C.J.L.); (E.H.W.)
- Institute for Breathing and Sleep (IBAS), Melbourne, VIC 3084, Australia
| | - Caroline J. Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3053, Australia; (J.Z.); (D.F.W.); (J.L.P.); (C.J.L.); (E.H.W.)
| | - E. Haydn Walters
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3053, Australia; (J.Z.); (D.F.W.); (J.L.P.); (C.J.L.); (E.H.W.)
- School of Medicine, University of Tasmania, Hobart, TAS 7000, Australia
| | - Shyamali C. Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3053, Australia; (J.Z.); (D.F.W.); (J.L.P.); (C.J.L.); (E.H.W.)
| |
Collapse
|
2
|
Marchant JM, Chang AB, Kennedy E, King D, Perret JL, Schultz A, Toombs MR, Versteegh L, Dharmage SC, Dingle R, Fitzerlakey N, George J, Holland A, Rigby D, Mann J, Mazzone S, O'Brien M, O'Grady KA, Petsky HL, Pham J, Smith SM, Wurzel DF, Vertigan AE, Wark P. Cough in Children and Adults: Diagnosis, Assessment and Management (CICADA). Summary of an updated position statement on chronic cough in Australia. Med J Aust 2024; 220:35-45. [PMID: 37982357 DOI: 10.5694/mja2.52157] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 09/18/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION Cough is the most common symptom leading to medical consultation. Chronic cough results in significant health care costs, impairs quality of life, and may indicate the presence of a serious underlying condition. Here, we present a summary of an updated position statement on cough management in the clinical consultation. MAIN RECOMMENDATIONS Assessment of children and adults requires a focused history of chronic cough to identify any red flag cough pointers that may indicate an underlying disease. Further assessment with examination should include a chest x-ray and spirometry (when age > 6 years). Separate paediatric and adult diagnostic management algorithms should be followed. Management of the underlying condition(s) should follow specific disease guidelines, as well as address adverse environmental exposures and patient/carer concerns. First Nations adults and children should be considered a high risk group. The full statement from the Thoracic Society of Australia and New Zealand and Lung Foundation Australia for managing chronic cough is available at https://lungfoundation.com.au/resources/cicada-full-position-statement. CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT Algorithms for assessment and diagnosis of adult and paediatric chronic cough are recommended. High quality evidence supports the use of child-specific chronic cough management algorithms to improve clinical outcomes, but none exist in adults. Red flags that indicate serious underlying conditions requiring investigation or referral should be identified. Early and effective treatment of chronic wet/productive cough in children is critical. Culturally specific strategies for facilitating the management of chronic cough in First Nations populations should be adopted. If the chronic cough does not resolve or is unexplained, the patient should be referred to a respiratory specialist or cough clinic.
Collapse
Affiliation(s)
- Julie M Marchant
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD
- Queensland Children's Hospital, Brisbane, QLD
| | - Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD
- Queensland Children's Hospital, Brisbane, QLD
- Menzies School of Health Research, Darwin, NT
| | - Emma Kennedy
- Rural and Remote Health, Flinders University, Darwin, NT
| | | | - Jennifer L Perret
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC
| | - Andre Schultz
- Wal-yan Respiratory Research Centre, Perth, WA
- Perth Children's Hospital, Perth, WA
| | | | | | - Shyamali C Dharmage
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC
| | | | | | - Johnson George
- Centre for Medicine Use and Safety, Monash University, Melbourne, VIC
| | - Anne Holland
- Alfred Health, Melbourne, VIC
- Monash University, Melbourne, VIC
- Institute for Breathing and Sleep, University of Melbourne, Melbourne, VIC
| | - Debbie Rigby
- University of Queensland, Brisbane, QLD
- Queensland University of Technology, Brisbane, QLD
| | - Jennifer Mann
- Institute for Breathing and Sleep, University of Melbourne, Melbourne, VIC
- Austin Health, Melbourne, VIC
| | | | | | - Kerry-Ann O'Grady
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD
| | | | | | | | | | - Anne E Vertigan
- Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW
- John Hunter Hospital, Newcastle, NSW
| | - Peter Wark
- Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW
- John Hunter Hospital, Newcastle, NSW
| |
Collapse
|
3
|
Liptzin DR, Neemann K, McCulloh R, Singleton R, Smith P, Carlson JC. Controversies in Antibiotic Use for Chronic Wet Cough in Children. J Pediatr 2024; 264:113762. [PMID: 37778412 PMCID: PMC11216076 DOI: 10.1016/j.jpeds.2023.113762] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/31/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Deborah R Liptzin
- University of Montana School of Public and Community Health Sciences, Missoula, MT; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA.
| | - Kari Neemann
- Department of Pediatrics, University of Nebraska Medical Center College of Medicine, Omaha, NE
| | - Russell McCulloh
- Department of Pediatrics, University of Nebraska Medical Center College of Medicine, Omaha, NE
| | | | - Paul Smith
- University of Montana School of Public and Community Health Sciences, Missoula, MT
| | | |
Collapse
|
4
|
Laird PJ, Chang AB, Walker R, Barwick M, Whitby J, Cooper MN, Gill F, McKinnon E, Schultz A. Evaluation of the implementation and clinical effects of an intervention to improve medical follow-up and health outcomes for Aboriginal children hospitalised with chest infections. THE LANCET REGIONAL HEALTH - WESTERN PACIFIC 2023. [DOI: 10.1016/j.lanwpc.2023.100708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
|
5
|
Laird PJ, Walker R, McCallum G, Toombs M, Barwick M, Morris P, Aitken R, Cooper M, Norman R, Patel B, Lau G, Chang AB, Schultz A. Change in health outcomes for First Nations children with chronic wet cough: rationale and study protocol for a multi-centre implementation science study. BMC Pulm Med 2022; 22:492. [PMID: 36581812 PMCID: PMC9798941 DOI: 10.1186/s12890-022-02219-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 11/02/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND In children, chronic wet cough may be a sign of underlying lung disease, including protracted bacterial bronchitis (PBB) and bronchiectasis. Chronic (> 4 weeks in duration) wet cough (without indicators pointing to alternative causes) that responds to antibiotic treatment is diagnostic of PBB. Timely recognition and management of PBB can prevent disease progression to irreversible bronchiectasis with lifelong consequences. However, detection and management require timely health-seeking by carers and effective management by clinicians. We aim to improve (a) carer health-seeking for chronic wet cough in their child and (b) management of chronic wet cough in children by clinicians. We hypothesise that implementing a culturally integrated program, which is informed by barriers and facilitators identified by carers and health practitioners, will result in improved lung health of First Nations children, and in the future, a reduced the burden of bronchiectasis through the prevention of the progression of protracted bacterial bronchitis to bronchiectasis. METHODS This study is a multi-centre, pseudorandomised, stepped wedge design. The intervention is the implementation of a program. The program has two components: a knowledge dissemination component and an implementation component. The implementation is adapted to each study site using a combined Aboriginal Participatory Action Research and an Implementation Science approach, guided by the Consolidated Framework of Implementation Research. There are three categories of outcome measures related to (i) health (ii) cost, and (iii) implementation. We will measure health-seeking as the proportion of parents seeking help for their child in a 6-month period before the intervention and the same 6-month period (i.e., the same six calendar months) thereafter. The parent-proxy, Cough-specific Quality of Life (PC-QoL) will be the primary health-related outcome measure. DISCUSSION We hypothesise that a tailored intervention at each site will result in improved health-seeking for carers of children with a chronic wet cough and improved clinician management of chronic wet cough. In addition, we expect this will result in improved lung health outcomes for children with a chronic wet cough. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry; ACTRN12622000430730 , registered 16 March 2022, Retrospectively registered.
Collapse
Affiliation(s)
- Pamela J. Laird
- grid.414659.b0000 0000 8828 1230Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA Australia ,grid.410667.20000 0004 0625 8600Perth Children’s Hospital, Perth, WA Australia ,grid.1012.20000 0004 1936 7910Division of Paediatrics, Faculty of Medicine, University of Western Australia, Perth, Australia
| | - Roz Walker
- grid.1012.20000 0004 1936 7910School of Indigenous Studies, Poche Centre for Indigenous Health, University of Western Australia, Perth, WA Australia ,grid.1012.20000 0004 1936 7910School of Population Health, University of Western Australia, Perth, WA Australia ,grid.1025.60000 0004 0436 6763Ngangk Yira Institute for Change, Murdoch University, Perth Western, Australia
| | - Gabrielle McCallum
- grid.1043.60000 0001 2157 559XChild Health Division Menzies School of Health Research, Charles Darwin University, NT Darwin, Australia
| | - Maree Toombs
- grid.1003.20000 0000 9320 7537Faculty of Medicine, University of Queensland, Brisbane, QLD Australia
| | - Melanie Barwick
- grid.42327.300000 0004 0473 9646Hospital for Sick Children, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Peter Morris
- grid.1043.60000 0001 2157 559XChild Health Division Menzies School of Health Research, Charles Darwin University, NT Darwin, Australia
| | - Robyn Aitken
- grid.1043.60000 0001 2157 559XChild Health Division Menzies School of Health Research, Charles Darwin University, NT Darwin, Australia ,grid.1014.40000 0004 0367 2697College of Medicine and Public Health, Flinders University, Adelaide, SA Australia ,grid.1043.60000 0001 2157 559XCharles Darwin University College of Indigenous Future, Arts & Society, Darwin, NT Australia
| | - Matthew Cooper
- grid.414659.b0000 0000 8828 1230Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA Australia
| | - Richard Norman
- grid.1032.00000 0004 0375 4078School of Population Health, Curtin University, Perth, WA Australia
| | - Bhavini Patel
- Northern Territory Department of Health, Darwin, NT Australia
| | - Gloria Lau
- grid.414659.b0000 0000 8828 1230Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA Australia ,grid.410667.20000 0004 0625 8600Perth Children’s Hospital, Perth, WA Australia
| | - Anne B. Chang
- grid.1043.60000 0001 2157 559XChild Health Division Menzies School of Health Research, Charles Darwin University, NT Darwin, Australia ,grid.240562.7Department of Respiratory Medicine, Queensland Children’s Hospital, Brisbane, QLD Australia ,grid.1003.20000 0000 9320 7537Australian Centre For Health Services Innovation, Qld University of Technology, Brisbane, QLD Australia
| | - André Schultz
- grid.414659.b0000 0000 8828 1230Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA Australia ,grid.410667.20000 0004 0625 8600Perth Children’s Hospital, Perth, WA Australia ,grid.1012.20000 0004 1936 7910Division of Paediatrics, Faculty of Medicine, University of Western Australia, Perth, Australia
| |
Collapse
|
6
|
Laird P, Ball N, Brahim S, Brown H, Chang AB, Cooper M, Cox D, Cox D, Crute S, Foong RE, Isaacs J, Jacky J, Lau G, McKinnon E, Scanlon A, Smith EF, Thomason S, Walker R, Schultz A, Walker R, Schultz A. Prevalence of chronic respiratory diseases in Aboriginal children: A whole population study. Pediatr Pulmonol 2022; 57:3136-3144. [PMID: 36098280 PMCID: PMC9825907 DOI: 10.1002/ppul.26148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/27/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND The burden of bronchiectasis is disproportionately high in Aboriginal adults, with early mortality. Bronchiectasis precursors, that is, protracted bacterial bronchitis (PBB) and chronic suppurative lung disease (CSLD), often commence in early childhood. We previously reported a 10% prevalence of PBB in Aboriginal children aged 0 to 7 years, however there are no data on prevalence of chronic lung diseases in older children. Our study aimed to determine the prevalence of PBB, CSLD, bronchiectasis, and asthma in Aboriginal children living in four communities. METHODS A whole-population cross-sectional community co-designed study of Aboriginal children aged <18-years in four remote communities in Western Australia across two-time points, a month apart. Children were assessed by pediatric respiratory clinicians with spirometry undertaken (when possible) between March-September 2021. Children with respiratory symptoms were followed up via medical record audit from either the local medical clinic or via a respiratory specialist clinic through to March 2022 to establish a final diagnosis. FINDINGS We recruited 392 (91.6%) of those in the selected communities; median age = 8.4 years (interquartile range [IQR] 5.1-11.5). Seventy children (17.9%) had a chronic respiratory pathology or abnormal spirometry results. PBB was confirmed in 30 (7.7%), CSLD = 13 (3.3%), bronchiectasis = 5 (1.3%) and asthma = 17 (4.3%). The prevalence of chronic wet cough significantly increased with increasing age. INTERPRETATION The prevalence of PBB, CSLD and bronchiectasis is high in Aboriginal children and chronic wet cough increases with age. This study highlights the high disease burden in Aboriginal children and the urgent need for strategies to address these conditions.
Collapse
Affiliation(s)
- Pamela Laird
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia.,Department of Physiotherapy, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Division of Paediatrics, Faculty of Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Nicola Ball
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia.,Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Shekira Brahim
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Henry Brown
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Anne B Chang
- Child Health Division Menzies School of Health Research, Darwin, Northern Territory, Australia.,Department of Respiratory Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,The Centre of Children's Health Research, Australian Centre For Health Services Innovation, Qld University of Technology, Brisbane, Queensland, Australia
| | - Matthew Cooper
- Telethon Kids Institute, Perth, Western Australia, Australia
| | - Deanne Cox
- Kimberley Aboriginal Medical Service, Broome, Western Australia, Australia
| | - Denetta Cox
- Kimberley Aboriginal Medical Service, Broome, Western Australia, Australia
| | - Samantha Crute
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia.,Department of Physiotherapy, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Rachel E Foong
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia.,School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Janella Isaacs
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - John Jacky
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Gloria Lau
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia.,Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | | | - Annie Scanlon
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia.,Broome Regional Hospital, Broome, Western Australia, Australia
| | - Elizabeth F Smith
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia.,School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Sarah Thomason
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia.,Broome Regional Hospital, Broome, Western Australia, Australia
| | - Roz Walker
- School of Indigenous Studies, Poche Centre for Indigenous Health, University of Western Australia, Perth, Western Australia, Australia.,School of Population Health, University of Western Australia, Perth, Western Australia, Australia.,Ngangk Yira Institute for Change, Murdoch University, Perth, Western Australia, Australia
| | - André Schultz
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia.,Division of Paediatrics, Faculty of Medicine, University of Western Australia, Crawley, Western Australia, Australia.,Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Roz Walker
- School of Indigenous Studies, Poche Centre for Indigenous Health, University of Western Australia, Perth, WA, Australia.,School of Population Health, University of Western Australia, Perth, WA, Australia.,Ngangk Yira Institute for Change, Murdoch University, Perth, WA, Australia
| | - André Schultz
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Northern Entrance, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA, 6009, Australia.,Department of Paediatrics, School of Medicine, University of WA, 35 Stirling Highway, Crawley, WA, 6009, Australia.,Respiratory and Sleep Medicine, Perth Children's Hospital, 15 Hospital Ave, Nedlands, 6009, WA, Australia
| |
Collapse
|
7
|
Chung KF, McGarvey L, Song WJ, Chang AB, Lai K, Canning BJ, Birring SS, Smith JA, Mazzone SB. Cough hypersensitivity and chronic cough. Nat Rev Dis Primers 2022; 8:45. [PMID: 35773287 PMCID: PMC9244241 DOI: 10.1038/s41572-022-00370-w] [Citation(s) in RCA: 94] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/19/2022] [Indexed: 12/13/2022]
Abstract
Chronic cough is globally prevalent across all age groups. This disorder is challenging to treat because many pulmonary and extrapulmonary conditions can present with chronic cough, and cough can also be present without any identifiable underlying cause or be refractory to therapies that improve associated conditions. Most patients with chronic cough have cough hypersensitivity, which is characterized by increased neural responsivity to a range of stimuli that affect the airways and lungs, and other tissues innervated by common nerve supplies. Cough hypersensitivity presents as excessive coughing often in response to relatively innocuous stimuli, causing significant psychophysical morbidity and affecting patients' quality of life. Understanding of the mechanisms that contribute to cough hypersensitivity and excessive coughing in different patient populations and across the lifespan is advancing and has contributed to the development of new therapies for chronic cough in adults. Owing to differences in the pathology, the organs involved and individual patient factors, treatment of chronic cough is progressing towards a personalized approach, and, in the future, novel ways to endotype patients with cough may prove valuable in management.
Collapse
Affiliation(s)
- Kian Fan Chung
- Experimental Studies Unit, National Heart & Lung Institute, Imperial College London, London, UK
- Department of Respiratory Medicine, Royal Brompton and Harefield Hospital, London, UK
| | - Lorcan McGarvey
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Anne B Chang
- Australian Centre for Health Services Innovation, Queensland's University of Technology and Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Division of Child Health, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Kefang Lai
- The First Affiliated Hospital of Guangzhou Medical University, National Center of Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | | | - Surinder S Birring
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Jaclyn A Smith
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Stuart B Mazzone
- Department of Anatomy and Physiology, University of Melbourne, Victoria, Australia.
| |
Collapse
|
8
|
Musgrove E, Gasparini L, McBain K, Clifford SA, Carter SA, Teede H, Wake M. Synthesizing Core Outcome Sets for outcomes research in cohort studies: a systematic review. Pediatr Res 2022; 92:936-945. [PMID: 34921214 PMCID: PMC8678579 DOI: 10.1038/s41390-021-01801-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 09/10/2021] [Accepted: 10/09/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Life course studies are designed to "collect once, use multiple times" for observational and, increasingly, interventional research. Core Outcome Sets (COS) are minimum sets developed for clinical trials by multi-stakeholder consensus methodologies. We aimed to synthesize published COS that might guide outcomes selection for early life cohorts with an interventional focus. METHODS We searched PubMed, Medline, COMET, and CROWN for COS published before January 2021 relevant to four life stages (pregnancy, newborns, children <8 years, and parents (adults aged 18-50 years)). We synthesized core outcomes into overarching constructs. RESULTS From 46 COS we synthesized 414 core outcomes into 118 constructs. "Quality of life", "adverse events", "medication use", "hospitalization", and "mortality" were consistent across all stages. For pregnancy, common constructs included "preterm birth", "delivery mode", "pre-eclampsia", "gestational weight gain", "gestational diabetes", and "hemorrhage"; for newborns, "birthweight", "small for gestational age", "neurological damage", and "morbidity" and "infection/sepsis"; for pediatrics, "pain", "gastrointestinal morbidity", "growth/weight", "breastfeeding", "feeding problems", "hearing", "neurodevelopmental morbidity", and "social development"; and for adults, "disease burden", "mental health", "neurological function/stroke", and "cardiovascular health/morbidity". CONCLUSION This COS synthesis generated outcome constructs that are of high value to stakeholders (participants, health providers, services), relevant to life course research, and could position cohorts for trial capabilities. IMPACT We synthesized existing Core Outcome Sets as a transparent methodology that could prioritize outcomes for lifecourse cohorts with an interventional focus. "Quality of life", "adverse events", "medication use", "hospitalization", and "mortality" are important outcomes across pregnancy, newborns, childhood, and early-to-mid-adulthood (the age range relevant to parents). Other common outcomes (such as "birthweight", "cognitive function/ability", "psychological health") are also highly relevant to lifecourse research. This synthesis could assist new early life cohorts to pre-select outcomes that are of high value to stakeholders (participants, health providers, services), are relevant to lifecourse research, and could position them for future trials and interventional capability.
Collapse
Affiliation(s)
- Erica Musgrove
- grid.1058.c0000 0000 9442 535XMurdoch Children’s Research Institute, Parkville VIC, Australia ,grid.1008.90000 0001 2179 088XDepartment of Paediatrics, The University of Melbourne, Parkville, VIC Australia
| | - Loretta Gasparini
- grid.1058.c0000 0000 9442 535XMurdoch Children’s Research Institute, Parkville VIC, Australia ,grid.1008.90000 0001 2179 088XDepartment of Paediatrics, The University of Melbourne, Parkville, VIC Australia
| | - Katie McBain
- grid.1058.c0000 0000 9442 535XMurdoch Children’s Research Institute, Parkville VIC, Australia ,grid.1008.90000 0001 2179 088XDepartment of Paediatrics, The University of Melbourne, Parkville, VIC Australia
| | - Susan A. Clifford
- grid.1058.c0000 0000 9442 535XMurdoch Children’s Research Institute, Parkville VIC, Australia ,grid.1008.90000 0001 2179 088XDepartment of Paediatrics, The University of Melbourne, Parkville, VIC Australia
| | - Simon A. Carter
- grid.1058.c0000 0000 9442 535XMurdoch Children’s Research Institute, Parkville VIC, Australia ,grid.1013.30000 0004 1936 834XSydney School of Public Health, The University of Sydney, NSW, Australia
| | - Helena Teede
- grid.1002.30000 0004 1936 7857Monash Centre of Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Clayton, VIC Australia ,grid.419789.a0000 0000 9295 3933Monash Endocrinology and Diabetes Units, Monash Health, Clayton, VIC Australia
| | - Melissa Wake
- Murdoch Children's Research Institute, Parkville, VIC, Australia. .,Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia. .,Liggins Institute, The University of Auckland, Grafton, Auckland, New Zealand.
| |
Collapse
|
9
|
Lau GTY, Laird P, Stevenson PG, Schultz A. Frequency of protracted bacterial bronchitis and management pre-respiratory referral. J Paediatr Child Health 2022; 58:97-103. [PMID: 34352136 DOI: 10.1111/jpc.15665] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/29/2021] [Accepted: 07/15/2021] [Indexed: 11/28/2022]
Abstract
AIM To determine the frequency of protracted bacterial bronchitis (PBB) in children referred to tertiary care with chronic cough and describe management prior to referral. METHODS A retrospective cohort study of all new patients with a history of ≥4 weeks of cough seen at the only tertiary paediatric outpatient respiratory service in Western Australia between July 2018 and June 2019. Medical records were reviewed until a final diagnosis was documented or otherwise for a period of 18 months. RESULTS PBB was the most common cause and comprised 37.9% of all children referred to tertiary respiratory care with chronic cough. In children with PBB, the median cough duration at the time of first specialist review was 5.1 months (IQR 2.1-12.0 months). The most common referral source of PBB was primary practice (40.9%) and the most common working diagnosis pre-referral was asthma (15.9%). Seventy-eight percent of children with PBB had an ongoing cough at their first respiratory review, and of these, only 13.5% had been prescribed 4 weeks of antibiotics prior to their respiratory review. Asthma treatment had been prescribed for 34.0% of children with PBB. CONCLUSION PBB is the most common cause of chronic cough in children referred to tertiary respiratory care and is frequently misdiagnosed and undertreated pre-referral. There is a need to facilitate diagnosis and optimal management of PBB in primary care, which could result in earlier symptom resolution and potentially limit disease progression to bronchiectasis.
Collapse
Affiliation(s)
- Gloria T Y Lau
- Department of Respiratory, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Pamela Laird
- Department of Physiotherapy, Perth Children's Hospital, Perth, Western Australia, Australia.,Wal-Yan Respiratory Research Centre, Telethon Kids Institute, Perth, Western Australia, Australia.,Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Paul G Stevenson
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Andre Schultz
- Department of Respiratory, Perth Children's Hospital, Perth, Western Australia, Australia.,Wal-Yan Respiratory Research Centre, Telethon Kids Institute, Perth, Western Australia, Australia.,Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
10
|
Laird P, Chang AB, Jacky J, Lane M, Schultz A, Walker R. Conducting decolonizing research and practice with Australian First Nations to close the health gap. Health Res Policy Syst 2021; 19:127. [PMID: 34551774 PMCID: PMC8456666 DOI: 10.1186/s12961-021-00773-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/24/2021] [Indexed: 11/10/2022] Open
Abstract
The purpose of this paper is to highlight a perspective for decolonizing research with Australian First Nations and provide a framework for successful and sustained knowledge translation by drawing on the recent work conducted by a research group, in five remote communities in North-Western Australia. The perspective is discussed in light of national and international calls for meaningful and dedicated engagement with First Nations people in research, policy and practice, to help close the health gap between First Nations and other Australians.
Collapse
Affiliation(s)
- Pamela Laird
- Wal-Yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia. .,Department of Physiotherapy, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA, 6009, Australia. .,The Child Health Division Menzies School of Health Research, Darwin, NT, Australia.
| | - Anne B Chang
- The Child Health Division Menzies School of Health Research, Darwin, NT, Australia.,Department of Respiratory Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia.,The Centre of Children's Health Research, Australian Centre for Health Services Innovation, Qld University of Technology, Brisbane, QLD, Australia
| | - John Jacky
- Kulunga, Telethon Kids Institute, Broome, WA, Australia
| | - Mary Lane
- Broome Regional Aboriginal Medical Service, Broome, WA, Australia
| | - André Schultz
- Wal-Yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.,Department of Paediatrics, School of Medicine, University of WA, Perth, Australia.,Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, WA, Australia
| | - Roz Walker
- School of Indigenous Studies, Poche Centre for Indigenous Health, University of Western Australia, Perth, WA, Australia
| |
Collapse
|
11
|
Korppi M. Is prolonged wet cough underdiagnosed and improperly treated in preschool children? Acta Paediatr 2020; 109:2446-2447. [PMID: 32964507 DOI: 10.1111/apa.15571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/03/2020] [Accepted: 09/08/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Matti Korppi
- Centre for Child Health Research Tampere University and University Hospital Tampere Finland
| |
Collapse
|
12
|
Laird P, Walker R, Lane M, Totterdell J, Chang AB, Schultz A. Recognition and Management of Protracted Bacterial Bronchitis in Australian Aboriginal Children: A Knowledge Translation Approach. Chest 2020; 159:249-258. [PMID: 32673622 DOI: 10.1016/j.chest.2020.06.073] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/05/2020] [Accepted: 06/03/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Chronic wet cough in children is the hallmark symptom of protracted bacterial bronchitis (PBB) and if left untreated can lead to bronchiectasis, which is prevalent in Indigenous populations. Underrecognition of chronic wet cough by parents and clinicians and underdiagnosis of PBB by clinicians are known. RESEARCH QUESTION We aimed to improve recognition and management of chronic wet cough in Aboriginal children using knowledge translation (KT), a methodologic approach that can be adapted for use in Indigenous contexts to facilitate effective and sustained translation of research into practice. STUDY DESIGN AND METHODS A mixed-methods KT study undertaken at a remote-based Aboriginal primary medical service (February 2017 to December 2019). Our KT strategy included the following: (1) culturally secure (ie, ensuring Aboriginal people are treated regarding their unique cultural needs and differences) knowledge dissemination to facilitate family health seeking for chronic wet cough in children, and (2) an implementation strategy to facilitate correct diagnosis and management of chronic wet cough and PBB by physicians. RESULTS Post-KT, health seeking for chronic wet cough increased by 184% (pre = eight of 630 children [1.3%], post = 23 of 636 children [3.6%]; P = .007; 95% CI, 0.7%-4.0%). Physician proficiency in management of chronic wet cough improved significantly as reflected by improved chronic cough-related quality of life (P < .001; 95% CI, 0.8-3.0) and improved physician assessment of cough quality (P < .001; 95% CI, 10.4%-23.0%), duration (P < .001; 95% CI, 11.1%-24.1%), and appropriate antibiotic prescription (P = .010; 95% CI, 6.6%-55.7%). INTERPRETATION Health seeking for children with chronic wet cough can be facilitated through provision of culturally secure health information. Physician proficiency in the management of PBB can be improved with KT strategies which include training in culturally informed management, leading to better health outcomes. Comprehensive strategies that include both families and health systems are required to ensure that chronic wet cough in children is detected and optimally managed.
Collapse
Affiliation(s)
- Pam Laird
- Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Australia; Department of Paediatrics, School of Medicine, University of Western Australia, Perth, WA, Australia; Department of Physiotherapy, Perth Children's Hospital, Australia.
| | - Roz Walker
- School of Indigenous Studies, Poche Centre for Indigenous Health, University of Western Australia, Australia
| | - Mary Lane
- Broome Aboriginal Medical Service, Australia
| | - James Totterdell
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Australia
| | - Anne B Chang
- Child Health Division Menzies School of Health Research, Department of Respiratory Medicine, Queensland Children's Hospital, Australia; Center of Children's Health Research, Australian Centre For Health Services Innovation, Qld University of Technology, Australia
| | - André Schultz
- Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Australia; Department of Paediatrics, School of Medicine, University of Western Australia, Perth, WA, Australia; Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Australia
| |
Collapse
|
13
|
Song WJ, An J, McGarvey L. Recent progress in the management of chronic cough. Korean J Intern Med 2020; 35:811-822. [PMID: 32422697 PMCID: PMC7373968 DOI: 10.3904/kjim.2020.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 03/09/2020] [Indexed: 02/07/2023] Open
Abstract
Chronic cough is a common clinical condition with significant impact on quality of life and for which effective therapy remains an unmet clinical need. Over the past decade, there has been a major shift in how we approach this problem, driven by better appreciation of the clinical manifestation of chronic cough and an improved understanding of the associated neurobiology. "Cough hypersensitivity syndrome" has been proposed as a new diagnostic term for chronic cough, encompassing different phenotypes of the condition. Accumulating evidence suggests that this new concept is clinically relevant. However, while it is gaining widespread endorsement within the allergy and respiratory community, raising its profile in routine clinical practice is a priority. Thus, the present paper reviews recent progress in our understanding and management of chronic cough, with focus on mechanistic and clinical studies. It also provides detail on knowledge gaps and future research directions.
Collapse
Affiliation(s)
- Woo-Jung Song
- Department of Allergy and Clinical Immunology, Airway Sensation and Cough Research Laboratory, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin An
- Department of Allergy and Clinical Immunology, Airway Sensation and Cough Research Laboratory, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Lorcan McGarvey
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| |
Collapse
|